The patient-centered medical home, electronic health records, and quality of care

Abstract

Background: The patient-centered medical home (PCMH) model of primary care is being implemented widely, although its effects on quality are unclear. The PCMH typically involves electronic health records (EHRs), organizational practice change, and payment reform.

Objective: To compare quality of care provided by physicians in PCMHs with that provided by physicians using paper medical records and, separately, with that provided by physicians using EHRs without the PCMH (to determine whether effects were driven by EHRs).

Design: Prospective cohort study (2008 to 2010). (ClinicalTrials.gov: NCT00793065).

Setting: The Hudson Valley, a 7-county, multipayer, multiprovider region in New York.

Participants: 675 primary care physicians in 312 practices and 143,489 patients.

Measurements: Claims for 10 quality measures from the Healthcare Effectiveness Data and Information Set were used. Differences in quality were determined using generalized estimating equations adjusted for 8 physician characteristics and 4 patient characteristics.

Results: The PCMH group improved significantly more over time than either the paper group or the EHR group for 4 of the 10 measures (by 1 to 9 percentage points per measure): eye examinations and hemoglobin A1c testing for patients with diabetes, chlamydia screening, and colorectal cancer screening (adjusted P < 0.05 for each). The odds of overall quality improvement in the PCMH group were 7% higher than in the paper group and 6% higher than in the EHR group (adjusted P < 0.01 for each).

Limitation: This study was observational, and the possibility of unmeasured confounders cannot be excluded.

Conclusion: The PCMH was associated with modest quality improvement. The aspects of the PCMH that drive improvement are distinct from but may be enabled by the EHR.

Primary funding source: The Commonwealth Fund and the New York State Department of Health.